Surgery in mycetoma-endemic villages: unique experience

Mohamed, El Samani Wadaa; Bakhiet, Sahar Mubarak; Nour, Mustafa El; Suliman, Suliman Hussein; Amin, Hajo Mohamed El; Fahal, Ahmed Hassan

doi:10.1093/trstmh/traa194

Cited by 8 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be due to the inadequate surgical excision in this group of patients. In mycetoma, a bloodless field using a tourniquet is vital for adequate excision with a clear margin without disturbing the mycetoma granuloma capsule [ 39 ]. This is not applicable in extrapedal mycetoma; hence, there is a higher risk of surgical recurrence.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological observations and management challenges in extrapedal mycetoma: A three-decade review of 420 cases

Alhaj,

Ahmed,

Hassan

et al. 2024

PLoS Negl Trop Dis

Self Cite

View full text Add to dashboard Cite

Mycetoma is a serious, destructive, disfiguring chronic granulomatous inflammatory disease affecting the subcutaneous tissues that spread to involve the skin, deep tissues and bone. The disease predominately affects the limbs, and extrapedal mycetoma is rarely reported. The reported extrapedal ones are characterised by high morbidity and mortality. This communication reports on 420 patients with extrapedal mycetoma seen and managed at the Mycetoma Research Centre (MRC), University of Khartoum, between January 1991 and December 2021. In this descriptive, cross-sectional, hospital-based study, the electronic records of all mycetoma-confirmed patients seen during the study period were carefully and meticulously reviewed. The confirmed patients with extrapedal mycetoma were included in this study. The study included 420 patients with extrapedal mycetoma, 298 (70.7%) had eumycetoma, and 122 (29.3%) had actinomycetoma. There were 343 male patients (81.7%) and 77 (18.3%) females, with a male-to-female ratio of 4:1. Their ages ranged between 1.5 and 95 years, with a median of 28 years. Most of the patients were students and farmers. The majority of patients were from El Gezira, North Kordofan, and the White Nile States. Mycetoma was painful in 21%, and a family history of mycetoma was recorded in 11.5% of patients. The buttocks (37.9%) and head and neck (16.9%) were affected most. Less frequently affected sites were the trunk and back (12%) each, abdominal and chest walls (4.5%) each and loin (1%). The prominent clinical presentation findings were multiple sinuses discharging grains (55%), massive swellings (46%), and lymphadenopathy (11.5%). Less commonly observed clinical findings were local hyperhidrosis (5.3%) and dilated tortuous veins close to mycetoma lesions (0.5%). The study showed that 204 patients (48.6%) had clinical improvement in terms of decreased lesion size and healing of sinuses following medical therapy. Sixty-six patients (15.7%) had no noticeable improvement. The lesion continued progressing despite treatment in 44 patients (10.5%). In the study, 118 patients were on regular follow-up, and in this group, a cure was documented in 25 patients (21.1%) with eumycetoma and 23 (19.4%) with actinomycetoma. Post-operative recurrence among eumycetoma patients was 40%, with a 1% mortality rate. The treatment outcome was unsatisfactory, characterised by a low cure rate, high recurrence (40%) and follow-up dropout (57%) rates. This emphasises the importance of early case detection and management, objective health education programmes and thorough patient counselling to urge people to seek treatment early and reduce dropouts.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiological observations and management challenges in extrapedal mycetoma: A three-decade review of 420 cases

Alhaj,

Ahmed,

Hassan

et al. 2024

PLoS Negl Trop Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…endemic villages [21]. Apart from the high cost of the machines, their downside is that they cannot be operated without extensive training.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound is minimally invasive and can differentiate actinomycetoma and eumycetoma based on hyper‐reflective echoes [ 20 ]. With portable ultrasound machines, it can also be used in endemic villages [ 21 ]. Apart from the high cost of the machines, their downside is that they cannot be operated without extensive training.…”

Section: Discussionmentioning

confidence: 99%

Diagnostics to support mycetoma management—Development of two target product profiles

Fongwen

Asiedu

Bakhiet

et al. 2022

Tropical Med Int Health

View full text Add to dashboard Cite

Objective Mycetoma is a neglected tropical disease caused by more than 70 different microorganisms and identified by the WHO as one of the high‐priority diseases for developing diagnostic tests. To ensure the production of diagnostic assays for use by clinical staff in endemic regions, target product profiles (TPPs) were designed. Methods We describe the development of two TPPs: one for a diagnostic test able to identify the causative agent of mycetoma and another that would determine when treatment could be stopped. The TPPs were developed by considering product use, design, performance, product configuration and costs. Results Version 1.0 TPPs for two uses were posted by WHO for a 1‐month online public consultation on 25 October 2021, and the final TPP was posted online on 5 May 2022. Conclusion A major difficulty encountered in developing both TPPs was the large number of agents able to cause mycetoma and the lack of specific biomarkers for most of them.

show abstract

“…Wide local surgical excision is the treatment of choice for non-responding eumycetoma and small, well-localized lesions, allowing better response to medical therapy [ 13 , 14 ]. However, postoperative recurrence rates occurred in up to 50% of cases [ 15 ].…”

Section: Discussionmentioning

confidence: 99%